1/6. Case report: reduction of low back pain in a professional golfer.Previous research agrees that the majority of injuries that affect male golfers are located in the lower back and that they are related to improper swing mechanics and/or the repetitive nature of the swing. This study describes the trunk motion and paraspinal muscle activity during the swing of a golfer with related low back pain (LBP) and assesses the effect of a 3-month period of muscle conditioning and coaching on these variables. motion of the trunk was measured using three-dimensional video analysis and electromyograms (EMGs) were recorded from the same six sites of the erector spinae at the start and end of the 3-month period. At the end of the period, the golfer was able to play and practice without LBP. Coaching resulted in an increase in the range of hip turn and a decrease in the amount of shoulder turn, which occurred during the swing. In addition, a reduction in the amount of trunk flexion/lateral flexion during the downswing occurred in conjunction with less activity in the left erector spinae. These changes may serve to reduce the torsional and compressive loads acting on the thoracic and lumbar spine, which in turn may have contributed to the cessation of the LBP and would reduce the risk of reoccurrence in the future. In conclusion, further research with more subjects would now be warranted in order to test the findings of this program for the prevention of low back in golfers as piloted in this case report.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/6. Effusion of the hips in a patient with tetraplegia.BACKGROUND: patients with spinal cord injury are at risk for knee effusion, most likely as a result of repetitive microtrauma. patients with paralysis are susceptible to effusions of the hip similar to those seen in documented cases regarding the knee. The etiology is likely similar and is related to repetitive microtrauma, such as that experienced when aggressive range of motion exercises are applied. DESIGN: Case report. SETTING: Acute rehabilitation department of a spinal cord injury center. FINDINGS: A 19-year-old man with a complete cervical spinal cord injury presented to acute rehabilitation on postinjury day 25 with a C6 American Spinal Injury association classification A injury, complete. He was found to have bilateral hip effusions. Joint aspiration yielded a right sterile hydroarthrosis and a left sterile hemarthrosis. During his rehabilitation stay, the patient developed one mildly elevated alkaline phosphatase level, but he showed no radiographic evidence of heterotopic ossification and maintained full passive range of motion of the hips. CONCLUSION: This case indicates that hip effusion may be a similar, less-common occurrence than knee effusion in patients with spinal cord injury. In this case, bilateral aseptic hip effusion was not associated with heterotopic ossification. More research is needed to determine the etiology and sequelae of this condition.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
3/6. axillary artery compression and thrombosis in throwing athletes.A 28-year-old major league baseball pitcher sustained an axillary artery thrombosis which was successfully treated with intraarterial urokinase. Subsequent angiography and duplex scanning with the arm elevated in the pitching position demonstrated inducible compression of the axillary artery by the humeral head as well as compression at the thoracic outlet. To determine the incidence of axillary and subclavian artery compression and to investigate the mechanism of injury, brachial artery blood pressures and duplex scans of the subclavian and axillary arteries were performed in both the neutral position and the throwing position in the 92 extremities of 19 major league baseball pitchers, 16 non-pitching major league players, and 11 nonathlete controls. A drop in blood pressure of greater than 20 mm Hg was noted in the position in 56% of extremities tested, with a loss of a detectable blood pressure in 13%. Compression of the axillary artery by the humeral head was documented in 83% of extremities, but in only 7.6% was a greater than 50% stenosis inducible. No statistical difference was found in the incidence of arterial compression between the three groups tested or between their dominant and nondominant extremities. dissection of the axillary artery in two cadavers documented that abduction and external rotation of the arm causes compression of the axillary artery by the humeral head, which acts as a fulcrum. We conclude that the repetitive mechanical trauma of the throwing motion can cause intermittent compression and contusion of the axillary artery by the humeral head and predisposes the athlete who throws to thrombosis of the axillary artery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/6. Stress fracture of the lateral metatarsals following double-stem silicone implant arthroplasty of the hallux metatarsophalangeal joint.Stress fractures of the lateral metatarsal bones occur frequently and are most commonly seen following repetitive trauma. However, such fractures rarely occur after reconstructive operations involving the hallux metatarsophalangeal joint. The authors report four patients who developed a lateral metatarsal stress fracture during the first year following use of a double-stem silicone implant to reconstruct the hallux and, in addition in the case of one patient, the second metatarsophalangeal joint. An analysis of all these patients established the incidence of this complication to be 3%. The etiology of these fractures appears to be an overloading of the lateral metatarsals secondary to some shortening of the hallux metatarsal or in reestablishing motion to the hallux metatarsophalangeal joint. All fractures healed without complication and did not result in further forefoot symptoms or deformities. However, this complication should be suspected when lateral metatarsalgia develops following silicone implant arthroplasty because roentgenograms initially may be normal.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/6. Stress fractures of the medial malleolus.Six athletes, all engaged in running activities at the time of injury, presented with tenderness over the medial malleolus and ankle effusion. Three patients had a fracture line which could be seen on radiographs. These patients were treated by open reduction and internal fixation using two 4.0 cancellous screws. The other three patients had normal radiographs but bone scans showed increased uptake over the medial malleolus. These patients were treated with cast and immobilization. We believe that each of these patients suffered a stress fracture of the medial malleolus. We suggest that the possibility of a stress fracture be considered in the differential diagnosis of patients who present with 1) chronic or subacute pain over the medial malleolus and ankle effusion, and 2) a history of running activity at the time of injury or running activities aggravating the pain. Bone scans appear to be more sensitive than radiographs in detecting a stress fracture of the medial malleolus. We propose that athletes with radiographic signs of a medial malleolar fracture who desire early return to full participation should be treated by open reduction and internal fixation. For these patients, early motion can be initiated. Other athletes whose fracture cannot be detected on radiographs but whose malleolus shows increased uptake in the area on bone scans can be treated nonsurgically with immobilization and then progressive increase in activity. All of our patients returned to full activity between 6 and 8 weeks after treatment was initiated.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
6/6. Hypothenar hammer syndrome in sports.Repetitive blunt trauma or single severe trauma to the hypothenar region may lead to traumatic thrombosis of the distal ulnar artery (hypothenar hammer syndrome, HHS). In the sports-related literature we found and analysed isolated cases attributed to injuries sustained during sporting activities such as baseball, badminton, handball, football, frisbee, softball, karate, weight-lifting and hockey. Further, we report the case of an amateur golf player with ischaemic symptoms of his left hand, where angiography revealed filling defects in the digital arteries associated with a corkscrew-like configuration of the distal ulnar artery. magnetic resonance imaging (MRI) scan demonstrated, at the level of the hamulus ossis hamati, accessory fibres of m. palmaris brevis forming a sling around the ulnar artery. Treatment by resection of the thrombosed a. ulnaris segment and replacement with an autologous vein graft resulted in complete relief of symptoms. Histological sections revealed partially organized thrombi adherent to the intimal surface with fragmentation of the internal elastic membrane, indicating a traumatic genesis. As the mechanism of injury, we suspected intensive golf playing with the grip style and subsequent motions leading to pressure injury of the hypothenar area and the underlying ulnar artery. Contraction of the anomalous muscle belly may have additionally compressed the artery, slowing down the arterial flow and promoting thrombosis. In most reported cases including our own, it took a relatively long time until the cause of the disease as traumatic was found and accepted. The initial repetitive blunt or single severe trauma initiating the HHS can easily be overlooked or ignored. After intimal damage of a. ulnaris, the beginning of symptoms may be prolonged and mislead one into thinking the cause is a collagen or vasospastic disease.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |